Clinical analysis of pancreatoduodenectomy.docVIP

 PAGE \* MERGEFORMAT 11 Clinical analysis of pancreatoduodenectomy [Keywords:] operating skills pancreatoduodenectomy 1 Indications Ampullary cancer , common bile duct cancer, duodenal tumor, pancreatic cancer, other malignancies, head of the pancreas (islet cell tumor, pancreatic cystadenocarcinoma, etc.), chronic pancreatic mass in pancreatic head inflammation can not be other than cancer, lymph nodes around the pancreatic head and its adjacent organs secondary to malignant tumors offenders, patients generally can withstand major surgery. 2 surgical procedures Pancreaticoduodenectomy procedure is more complicated, difficult, long time, blood loss volume, but generally can be categorized into three major steps, namely, anatomical exploration and organ resection and reconstruction of the three parts of the digestive tract. (1) anatomical exploration: pancreaticoduodenectomy for the treatment of pancreatic cancer, the first should determine whether this procedure aims to achieve curative resection, tumor invasion has been found to be completely removed beyond the scope of, they should palliative surgery was converted immediately (such as biliary enteric drainage to reduce jaundice), and therefore surgical exploration, there should be planned so that at any time to modify the surgical plan. 1) intra-abdominal exploration: laparotomy should be noted that ascites and peritoneal metastases. Exploration of the sequence should be far and near, followed by pelvic, gastrointestinal, and then check the hilar, hepatoduodenal ligament, around the celiac artery , mesenteric root, para-aortic lymph node metastasis. After a detailed examination of the system can determine whether the intra-abdominal tumor distant metastasis. 2) Local exploration: To observe the common bile duct dilatation, with or without tumors or stones touching them. Then revealed descending part and the head of the pancreas in front of the limitations of p